The topic of traumatizing has a particularly great, existential relevance. In existential analysis the specificity of grave traumatizing is considered to be the experience of „horror“ at seeing the abysmal side of one’s being (instead of the void). This central experience in traumatizing is looked at on two levels. The process level is examined via an analysis of the self-structure, with the existential-analytical model of self-structure being close to the one propounded by Ch. Scharfetter.

On the structural level all four fundamental dimensions of fulfilled existence are touched by grave traumatizing. This explains the genesis of PTSD (post-traumatic stress disorder) as well as the high comorbidity factor of this disorder. As a direct conse­quence of trauma the interaction with the existential structure is reduced, causing a loss of world, relationship, self and future. Characteristic coping reactions accompany all experience – above all the death-feigning reflex and activism on the first fundamental motivation.

Therapy must restructure the existential fundamental references and the functioning of the person. The model of the fundamental motivations provides specific therapeutic steps to overcome the existential deracina­tion and to mobilise the functions of the person with the help of non-specific factors such as dialogue and encounter.

Key words: person, existence, rehabilitation, existential fundamental motivations, relation to the self, relation to the world

This paper deals with the necessity of enhancing the clinical-psychological rehabilitation of patients with a cranial-cerebral trauma and to complement deficient conceptions that try to reduce a person’s inner life to consciousness and therefore regard psychological processes only from the point of view of their defects.

The paper describes and reflects on the process that people go through with themselves and the world when they awake from a coma (a state of non-being). The guiding scheme was the concept of the basic dimensions of existence: the relation to the world, to life, to oneself and to the future (corresponding to the four existential -fundamental motivations by A. Längle). They also constitute the frame for the stages of re-establishing contact with oneself and the world around.

Stage can be seen as the simple experience of being, the feeling of „I am here.“ This is followed by the stages of „being able to be“ (1st FM), of „espousing life“ (2nd FM), the regeneration of a self-image and the foundation of self-worth (3rd FM); the fourth stage is about finding meaning (4th FM).

Trauma has always been part of the human condition. Ever since the introduction of the diagnostic entity of the posttraumatic stress disorder in the psychiatric classification system DSM-III in 1980 research into the bio-psycho-social effects of traumatic experiences on the human body and mind as well as on society has increased enormously. After a review of the current theoretical conceptions of psychotraumatology the diagnostic spectrum of post;trauma;tic disorders is presented. A presentation of epidemiological data and a discussion of the most important protective and risk factors as well as a description of the natural course follows. This knowledge is essential for planning the therapy. Posttraumatic stress disorders are primarily treated by psychotherapy with the cognitive-behavioural approaches currently showing the best proofs of efficiency. Pharmatherapeutic interventions only enter into question in second place. Therapy of people with complex posttraumatic stress disorders often demand a multimodal, multiprofessional approach with psychotherapy playing an important, but in no way in itself sufficient role.

Die neurobiologische Verankerung traumatischer Erfahrungen

Gerald Hüther

Key words: coping, neuroplasticity, stress, Traumatization

Traumatic experiences elicit an uncontrollable activation of stress-sensitive cortico-limbic neuronal networks and neuroendocrine circuits. The overshooting excitation in conjunction with strong and long-lasting activation of the HPA-System and cortisol secretion causes a destabilization of established neuronal circuitry (dentritic degeneration, synaptic regression) in brain regions with high cortisol receptor density and glutamatergic input (e.g. the hippocampus). Under these conditions, most victims of a trauma switch back into a pattern of „behavioral emergency reactions“ (freezing, panic, stereotypies) and a variety of self-protective, defensive response-pat­terns (dissociation, depersonalization, de­rea­li­zation). The more the neuronal and synaptic connections involved in the genera­tion of these defense responses become facilitated and stabilized, the more auto­matized the response. It is difficult under these conditions to acquire novel, more complex (frontocortical) patterns of coping, especially for children. More detrimental to the internal organization of the brain than the actually experienced trauma is the sub­jec­tively felt loss or destruction of security-providing resources (psychosocial support, self-image, competence, faith and belief). Therapeutic interventions must therefore aim at the restoration of these resources.

Trauma und Persönlichkeit

Luise Reddemann

Key words: personality disorder, trauma

In the last years interest has increased in the question of whether a correlation can be established between personality disorders and consequences of trauma and whether this could lead to a different and more productive understanding. The presentation shows the effects of serious traumatisation on the personality and the changes produced in the personality. Furthermore the well-known personality disorders will be discussed against the background of a posttraumatic understanding.